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Mechanical heart valve noise disturbs sleep for 23% of recipients, researchers reported from a single-center survey of patients presented at the EuroHeartCare meeting in Jonkoping, Sweden.
Insomnia was most closely predicted by valve noise perception, with a linear association between the two as well as between being disturbed by the sound and insomnia.
Most patients said they could hear the closing of the valve (87% of men and 75% of women), and 51% said others could hear it at least sometimes, too. While relatively few said they were bothered by the valve sound during the day or when others could hear it, women were more disturbed by the sound than men.
"We are not very proactive about this issue at the moment," lead author Kjersti Oterhals, PhD, of Haukeland University Hospital in Bergen, Norway, said in a press release. "It would improve many patients' quality of life if we asked them about valve noise and provided advice to those who find it distressing."
Neighborhood Diversity
Wide variations in cardiovascular mortality among U.S. counties were reported earlier this week, but neighborhood characteristics are key as well. An analysis of the CARDIA study in JAMA Internal Medicine turned up systematically higher blood pressure among blacks in more racially-segregated neighborhoods.
Most of the 2,280 non-Hispanic black adults in the cohort -- study locations were in Birmingham, Ala.; Chicago; Minneapolis; and Oakland, Calif. -- lived in highly segregated areas (81.6%). For each standard deviation of a racial segregation measurement, systolic blood pressure increased by a mean of 0.16 mm Hg, adjusted for interactions of time with age, sex, and field center.
Notably, moving to a less segregated area was associated with more than 1 mm Hg average reduction in systolic blood pressure.
"Findings from our observational study suggest that social policies that minimize segregation, such as the opening of housing markets, may have meaningful health benefits, including the reduction of blood pressure," the researchers concluded.
Low-Volume Vascular Surgery
Open abdominal aortic aneurysm repair (OAR) and carotid endarterectomy (CEA) are less often being done by surgeons who only occasionally do a case, but those cases have poor outcomes and higher costs, a study of the mandatory-reporting New York State database showed in JAMA Surgery.
Surgeons who did one or fewer such vascular surgeries per year accounted for 51.8% of the OARs and 47.8% of the CEAs done in the state, although the proportions and numbers declined from 2000 to 2014.
Compared against treatment by higher-volume surgeons, these very low-volume operators yielded twofold higher in-hospital mortality after OAR and about 80% relatively higher risks of postoperative MI and stroke after CEA. Length of hospital stay after OAR and CEA-related charges and 30-day readmission were all about 30% higher for patients treated by the very-low versus higher-volume surgeons.
Despite the decline, "it remains concerning, given ready access to higher-volume surgeons," the researchers concluded. "Efforts to eliminate this practice pattern are warranted to ensure high-quality care for all patients."
A variety of volume thresholds have been proposed for regionalization of these procedures, but one a year "may be a reasonable place to start," an accompanying editorial noted.
Vascular Surgery Model
A new method of soft-embalming deceased donors for vascular surgery training "created a high-fidelity isolated limb perfusion model of a femoral artery to popliteal artery bypass with saphenous vein harvesting," researchers reported in JAMA Surgery.
The same strategy could be translated to upper extremity procedures and even percutaneous interventions, the researchers noted.
Preservation processes usually limit the ability to perfuse due to loss of vascular tone and tissue pliability as well as leaving the vasculature often full of clot. While cost can be a barrier (the preservation process costs about $2,500), it leaves the embalmed body "supple and lifelike" for up to 2 years, allowing multiple training sessions.
"The clinical relevance of this model results in an excellent teaching tool for trainees at all levels in a safe, controlled setting," the researchers suggested. "These 'live' practice sessions will result in better preparation for real-world operations and will ease the transition from trainee to attending surgeon."
In Other News
For mechanical thrombectomy in acute ischemic stroke, conscious sedation wasn't safer for neurologic outcomes than was general anesthesia in a small randomized trial reported in Stroke.